Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry

Heidi Mochari-Greenberger, Ying Xian, Anne S. Hellkamp, Phillip Schulte, Deepak L. Bhatt, Gregg C. Fonarow, Jeffrey L. Saver, Mathew J. Reeves, Lee H. Schwamm, Eric E. Smith

Research output: Contribution to journalArticle

22 Scopus citations


BACKGROUND: Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients.

METHODS AND RESULTS: We analyzed data from 398,798 stroke patients admitted to 1613 Get With The Guidelines-Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms.

CONCLUSIONS: EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.

Original languageEnglish (US)
Pages (from-to)e002099
JournalJournal of the American Heart Association
Issue number8
StatePublished - Aug 12 2015
Externally publishedYes



  • disparities
  • emergency medical services
  • race/ethnicity
  • sex
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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